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Little is known about mental health problems of children and young people (CYP) involved with public and private law family court proceedings, and how these CYP fare compared to those not involved in these significant disruptions to family life.
This study examined records of depression/anxiety in CYP involved in public and private law proceedings using linked population-level data across Wales.
Retrospective e-cohort study. We calculated the incidence of primary-care-recorded depression/anxiety among CYP involved in these proceedings and in a comparison group, using Poisson regression. Depression/anxiety outcomes following proceedings were evaluated using pairwise Cox regression, with age- and gender-matched controls of CYP who had no involvement with the courts.
CYP in the public group had twice the risk of depression (adjusted incidence rate ratio aIRR = 2.2; 95% CI 1.9–2.6) and 20% higher risk of anxiety (aIRR = 1.2; 95% CI 1.0–1.5) relative to the comparison group. The private group had 60% higher risk of depression (aIRR = 1.6; 95% CI 1.4–1.7) and 30% higher risk of anxiety (aIRR = 1.3; 95% CI 1.2–1.4). Following private law proceedings, CYP were more likely to have depression (hazard ratio HR = 1.9; 95% CI 1.7–2.1), and anxiety (HR = 1.4; 95% CI 1.2–1.6) than the control group. Following public proceedings, CYP were more likely to have depression (HR = 2.1; 95% CI 1.7–2.5). Incidence of anxiety or depression following court proceedings was around 4%.
Findings highlight the vulnerability of CYP involved in family court proceedings and increased risk of depression and anxiety. Schools, health professionals, social and family support workers have a role to play in identifying needs and ensuring CYP receive appropriate support before, during and after proceedings.
The Trial Innovation Network has established an infrastructure for single IRB review in response to federal policies. The Network’s single IRB (sIRBs) have successfully supported over 70 multisite studies via more than 800 reliance arrangements. This has generated several lessons learned that can benefit the national clinical research enterprise, as we work to improve the conduct of clinical trials. These lessons include distinguishing the roles of the single IRB from institutional Human Research Protections programs, establishing a consistent sIRB review model, standardizing collection of local context and supplemental, study-specific information, and educating and empowering lead study teams to support their sites.
De nombreux aspects du droit de la famille de Hong Kong demeurent inchangés depuis des années, malgré la nécessité d’une réforme mise en lumière par une jurisprudence abondante. Depuis plusieurs années maintenant, les tribunaux ont été saisi de contestations relatives à la nature exclusivement hétérosexuelle du mariage et cette année n’a pas été différente. Il semble désormais évident qu’une vaste contestation de la nature du mariage échouera devant les tribunaux, tandis qu’une lente réduction du privilège attaché à l’état matrimonial hétérosexuel se poursuivra, petit à petit, sur la base d’arguments antidiscriminatoires spécifiques à chaque cas. Comme les affaires portées devant les tribunaux cet année l’ont montré, la loi sur l’adoption est une nouvelle opportunité manquée de réforme, les enfants payant le prix fort en termes de délais inutiles pour aboutir à l’adoption. Le pouvoir judiciaire a peu de marge de manoeuvre pour que la loi demeure adaptée et pertinente sans franchir les limites d’un activisme judiciaire inadmissible. Le droit de la famille de Hong Kong a désespérément besoin d’une réforme législative globale, fondée sur des principes et des pratiques reconnues.
This year's chapter on Hong Kong, like previous contributions, offers a review of recent developments in Hong Kong's family law in the absence of ‘grand plan’ legislative reform, and argues that, despite the ongoing best efforts of the judiciary to maintain the relevance of Hong Kong's family law, there is a desperate need for renewed engagement with the process of legislative reform in a number of key areas, with specific focus this year on marriage and adoption.
No one could deny that Hong Kong has had a difficult two years, with extensive civil rights protests starting in 2019, coupled in the past 12 months with the impact of COVID-19. Understandably, legislative reform of family law may not have been top of the agenda during these times. However, the fact is that there has been a lack of significant legislative innovation in family law for several years.
The issue of whether law should lead public opinion or vice versa is complex and well-traversed in jurisprudential debate, and not a subject that can be adequately addressed here.
Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research.
The COVID-19 pandemic changed the clinical research landscape in America. The most urgent challenge has been to rapidly review protocols submitted by investigators that were designed to learn more about or intervene in COVID-19. International Review Board (IRB) offices developed plans to rapidly review protocols related to the COVID-19 pandemic. An online survey was conducted with the IRB Directors at Clinical and Translational Science Awards (CTSA) institutions as well as two focus groups. Across the CTSA institutions, 66% reviewed COVID-19 protocols across all their IRB committees, 22% assigned protocols to just one committee, and 10% created a new committee for COVID-19 protocols. Fifty-two percent reported COVID-19 protocols were reviewed much faster, 41% somewhat faster, and 7% at the same speed as other protocols. Three percent reported that the COVID-19 protocols were reviewed with much better quality, 32% reported slightly better quality, and 65% reported the reviews were of the same quality as similar protocols before the COVID-19 pandemic. IRBs were able to respond to the emergent demand for reviewing COVID-19 protocols. Most of the increased review capacity was due to extra effort by IRB staff and members and not changes that will be easily implemented across all research going forward.
Rapid whole genome sequencing (rapid WGS) is a powerful diagnostic tool that is becoming increasingly practical for widespread clinical use. However, protocols for its use are challenging to implement. A significant obstacle to clinical adoption is that laboratory certification requires an initial research development phase, which is constrained by regulations from returning results. Regulations preventing return of results have ethical implications in cases which might impact patient outcomes. Here, we describe our experience with the development of a rapid WGS research protocol, that balanced the requirements for laboratory-validated test development with the ethical needs of clinically relevant return of results.
Background: Healthcare-associated infections caused by antibiotic-resistant organisms (AROs) are a major cause of significant morbidity and mortality. To create and optimize infection prevention strategies, it is crucial to delineate the role of the environment and clinical infections. Methods: Over a 14-month period, we collected environmental samples, patient feces, and patient bloodstream infection (BSI) isolates in a newly built bone marrow transplant (BMT) intensive care unit (ICU). Samples were collected from 13 high-touch areas in the patient room and 4 communal areas. Samples were collected from the old BMT ICU, in the new BMT ICU before patients moved in, and for 1 year after patients moved in. Selective microbiologic culture was used to isolate AROs, and whole-genome sequencing (WGS) was used to determine clonality. Antibiotic susceptibility testing was performed using Kirby-Bauer disk diffusion assays. Using linear mixed modeling, we compared ARO recovery across time and sample area. Results: AROs were collected and cultured from environmental samples, patient feces, and BSI isolates (Fig. 1a). AROs were found both before and after a patient entered the ICU (Fig. 1b). Sink drains had significantly more AROs recovered per sample than any other surface area (P < .001) (Fig. 1c). The most common ARO isolates were Pseudomonas aeruginosa and Stenotrophomonas maltophila (Fig. 1d). The new BMT ICU had fewer AROs recovered per sample than the old BMT ICU (P < .001) and no increase in AROs recovered over the first year of opening (P > .05). Furthermore, there was no difference before versus after patients moved into the hospital (P > .05). Antibiotic susceptibility testing reveal that P. aeruginosa isolates recovered from the old ICU were resistant to more antibiotics than isolates recovered from the new ICU (Fig. 2a). ANI and clonal analyses of P. aeruginosa revealed a large cluster of clonal isolates (34 of 76) (Fig. 2b). This clonal group included isolates found before patients moved into the BMT ICU and patient blood isolates. Furthermore, this clonal group was initially found in only 1 room in the BMT ICU, and over 26 weeks, it was found in sink drains in all 6 rooms sampled (Fig. 2b). Conclusions: AROs are present before patients move into a new BMT ICU, and sink drains act as a reservoir for AROs over time. Furthermore, sink-drain P. aeruginosa isolates are clonally related to isolates found in patient BSIs. Overall, these results provide insight into ARO transmission dynamics in the hospital environment.
Funding: Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.
À Hong Kong, plusieurs raisons expliquent qu’une réforme cohérente en droit de la famille se fait attendre depuis quelque temps déjà. Alors que dans le courant des dernières années des réformes touchant plusieurs aspects du droit de la famille avaient été engagées, peu de celles-ci ont abouti, souvent en raison de préoccupations soulevées au sein de l’Administration ou de la Législature, ou des deux. Face à ces préoccupations, le processus de réforme semble chaque fois se mettre à l’arrêt et l’on constate une absence de tout sentiment de nécessité ou d’urgence, malgré les nombreux appels provenant de différents acteurs du monde juridique et de la société civile en faveur d’une action législative. Malgré les efforts soutenus au cours des dernières années des magistrats qui par leur jurisprudence et leurs règles de pratique tentent de moderniser et d’améliorer le contenu et la pratique du droit familial, le leitmotiv de Hong Kong en 2019 a encore été pragmatique et à la pièce plutôt que représenter la mise en place d’une réforme globale du droit de la famille, comme ce chapitre montrera.
In many ways 2019 has not been a good year for Hong Kong. From June onwards the streets were taken over, weekend after weekend, for several months by large numbers of residents protesting against proposed extradition legislation that they feared would facilitate future infringement of their fundamental freedoms. Those protests developed in places into riots with running battles between some protestors and police, allegations of brutality on both sides and public institutions being damaged or shut down.
In these circumstances few governments could be criticised for failing to develop and implement a coherent programme of family law reform. In Hong Kong however there has arguably been little in the way of coherent legislative reform of family law for several years now. While the process of reform of a number of aspects of family law has been initiated over the past several years, few reforms are finalised and implemented, often due to concerns raised before either the Administration or the Legislature, or both. Once those concerns have been raised, the reform process seems to stall, with little sense of a need for urgent action, notwithstanding the myriad calls for legislative change from various quarters of the legal community and civil society.
This research was undertaken on the lands of the Wurundjeri people of the Kulin nation. We pay our respects to Elders of the past, present and emerging, and also acknowledge the generous contribution to this research made by women and their families and Victorian Aboriginal Child Care Agency (VACCA) staff. Aboriginal Cradle to Kinder (AC2K) is a home-visiting and advocacy programme focussed on promoting Aboriginal maternal and child health during both pre- and postnatal stages of parenthood which was delivered by VACCA, an Aboriginal Community Controlled Organisation. While there have been some feasibility assessments conducted on AC2K, no study to date has evaluated the impact of this programme from the perspective of neither the women nor the staff who deliver the programme. The aim of this study, therefore, was to evaluate how both the women and the staff evaluated the AC2K programme, namely the strengths, limitations and recommendations of the programme. Through consultation with VACCA, this study used a qualitative approach using interpretative phenomenological analysis to explore the processes underpinning the programme coupled with participants’ experiences of the programme. A co-design process was used in the development of interview questions, and a total of seven women and six workers participated in semi-structured interviews. The results revealed three superordinate themes across both participant groups: cultural connection (i.e. how well the programme facilitates cultural connection), system complexities (i.e. caseloads, staff turnover and child protection [CP] difficulties) and programme features (i.e. parenting enhancement and unique programme benefits). The processes, and the programme more broadly, were evaluated positively by both the women and staff who supported its delivery. Specifically, a greater connection to culture, increased parenting skills and unique programme benefits were reported. However, there were recommendations on how the programme could be further strengthened, including negotiable caseloads with the Department and improved partnership with CP. These changes can help to further improve the experiences of both the women and their workers when engaging in Aboriginal specific maternal health and well-being supports.
Mexican Americans suffer from a disproportionate burden of modifiable risk factors, which may contribute to the health disparities in mild cognitive impairment (MCI) and Alzheimer’s disease (AD).
The purpose of this study was to elucidate the impact of comorbid depression and diabetes on proteomic outcomes among community-dwelling Mexican American adults and elders.
Data from participants enrolled in the Health and Aging Brain among Latino Elders study was utilized. Participants were 50 or older and identified as Mexican American (N = 514). Cognition was assessed via neuropsychological test battery and diagnoses of MCI and AD adjudicated by consensus review. The sample was stratified into four groups: Depression only, Neither depression nor diabetes, Diabetes only, and Comorbid depression and diabetes. Proteomic profiles were created via support vector machine analyses.
In Mexican Americans, the proteomic profile of MCI may change based upon the presence of diabetes. The profile has a strong inflammatory component and diabetes increases metabolic markers in the profile.
Medical comorbidities may impact the proteomics of MCI and AD, which lend support for a precision medicine approach to treating this disease.
Working in Hong Kong, an international hub blessed with vibrant domestic and expatriate communities, family law practitioners respond to manifold enquiries oft en driven by social and technological change and different cultural expectations. How is Hong Kong's family law evolving to meet the changing needs of this dynamic, multi-faceted community?
Whilst Hong Kong's family law has responded innovatively to some of the challenges brought in recent years, perhaps most notably the Court of Final Appeal's support in LKW v. DD for a move from needs-based ancillary relief to a starting point of equal division of matrimonial property, it is also true to say that change has sometimes been more cautious. For example, consider the very carefully drawn decision of the Court of Final Appeal in W v. Registrar of Marriages on the scope for marriage by a transsexual in their reassigned gender identity.
While earlier resistance to legal recognition of same-sex relationships, parental responsibility in lieu of parental authority, and children as rights-holders rather than the ‘property’ of parents, suggests a tension between a ‘traditional’, hetero-normative, hierarchical concept of family life and a more progressive vision of family life and family law, 2018 saw key developments challenging the dominance of a ‘traditional’ family law. Nonetheless, the question remains: is the pace of change so glacial that any impact is only illusory?
LIMITED LEGAL RECOGNITION OF SAME-SEX RELATIONSHIPS
In 2018, two sets of legal proceedings, each claiming legal recognition of same sex-relationships in relation to spousal benefits, travelled through the courts.
The first case, Leung Chun Kwong v. Secretary for the Civil Service, was an appeal and cross-appeal to the Court of Appeal (CA) from the judgment of the Court of First Instance (CFI). The applicant – a Senior Immigration Officer – employed by the Civil Service and a Hong Kong permanent resident, had legally married his same-sex partner in New Zealand in 2014. Back in Hong Kong, he subsequently claimed financial spousal benefits which were denied. He then sought a judicial review of the decisions against him. The CFI found in his favour in relation to the Secretary for Civil Service's refusal to extend spousal medical and dental benefits to his same-sex husband.
Infants with CHD often experience growth failure. Ensuring optimal growth before surgery is associated with improved outcomes and has emerged as a significant cause of parental stress. Parents have reported a perceived lack of accessible feeding information for infants with CHD. To address this gap, the aim of this study was to develop feeding information to better support parents.
Materials and methods:
A search for existing material on six electronic databases and an internet search for unpublished (grey) literature on feeding information for infants with CHD were carried out. Following the development of feeding information, semi-structured interview(s) with parents/health-care professionals were completed, focusing on whether the information was easy to understand, relevant, provided sufficient information around feeding/feeding difficulties, and whether there were any information gaps. Iterative changes were made to the information following each interview. The process was completed until thematic saturation was achieved.
A total of 23 unique articles were identified of which 5 studies were included. From the grey literature, four web pages were reviewed. A total of 22 parents and 25 health-care professionals were interviewed. All parents/health-care professionals felt that the feeding information developed provided sufficient information; however, many wanted information on how to introduce complementary food, particularly if weaning was delayed.
This study describes the development of feeding information for infants with CHD. From parent interviews, gaps identified focused on the introduction of complementary foods and uncertainty regarding the feeding journey beyond surgery.
Centenarians have survived into very late life, but whether they reach very old age in good health remains unclear. The purpose of this study was to compare the cardiovascular health status and cognitive functioning of centenarians in the United States with centenarians in Japan.
Design, Setting, and Participants:
This cross-national design compared centenarians from the United States and Japan. The sample of U.S. centenarians was recruited from the Georgia Centenarian Study and included 287 centenarians. The sample of Japanese centenarians was recruited from the Tokyo Centenarian Study and included 304 centenarians.
Cognitive functioning was assessed with a mental status questionnaire, and cardiovascular disease by a health history assessment, blood pressure, and selected blood parameters.
The results suggest that Tokyo centenarians had lower disease experiences and BMI values, when compared to Georgia centenarians, but blood pressure was higher among Japanese centenarians. Lower levels of hemoglobin in Japanese centenarians and higher levels of C-reactive protein in Georgia were also found. The positive association of hypertension and albumin levels with cognitive functioning and the negative association of stroke occurrence with cognitive functioning were replicated in both countries. Differential effects were obtained for heart problems, BMI, and C-reactive protein (with positive effects for Tokyo centenarians, except for C-reactive protein).
For extremely old individuals, some markers of cardiovascular disease are replicable across countries, whereas differential effects for cardiovascular health also need to be considered in cardiovascular health.
Pacific Island countries are experiencing a high burden of diet-related non-communicable diseases; and consumption of fat, sugar and salt are important modifiable risk factors contributing to this. The present study systematically reviewed and summarized available literature on dietary intakes of fat, sugar and salt in the Pacific Islands.
Electronic databases (PubMed, Scopus, ScienceDirect and GlobalHealth) were searched from 2005 to January 2018. Grey literature was also searched and key stakeholders were consulted for additional information. Study eligibility was assessed by two authors and quality was evaluated using a modified tool for assessing dietary intake studies.
Thirty-one studies were included, twenty-two contained information on fat, seventeen on sugar and fourteen on salt. Dietary assessment methods varied widely and six different outcome measures for fat, sugar and salt intake – absolute intake, household expenditure, percentage contribution to energy intake, sources, availability and dietary behaviours – were used. Absolute intake of fat ranged from 25·4 g/d in Solomon Islands to 98·9 g/d in Guam, while salt intake ranged from 5·6 g/d in Kiribati to 10·3 g/d in Fiji. Only Guam reported on absolute sugar intake (47·3 g/d). Peer-reviewed research studies used higher-quality dietary assessment methods, while reports from national surveys had better participation rates but mostly utilized indirect methods to quantify intake.
Despite the established and growing crisis of diet-related diseases in the Pacific, there is inadequate evidence about what Pacific Islanders are eating. Pacific Island countries need nutrition monitoring systems to fully understand the changing diets of Pacific Islanders and inform effective policy interventions.
Interventions to reduce adolescents’ non-core food intake (i.e. foods high in fat and sugar) could target specific people or specific environments, but the relative importance of environmental contexts v. individual characteristics is unknown.
Data from 4d food diaries in the UK National Diet and Nutrition Survey (NDNS) 2008–2012 were analysed. NDNS food items were classified as ‘non-core’ based on fat and sugar cut-off points per 100g of food. Linear multilevel models investigated associations between ‘where’ (home, school, etc.) and ‘with whom’ (parents, friends, etc.) eating contexts and non-core food energy (kcal) per eating occasion (EO), adjusting for variables at the EO (e.g. time of day) and adolescent level (e.g. gender).
Adolescents (n 884) aged 11–18 years.
Only 11 % of variation in non-core energy intake was attributed to differences between adolescents. In adjusted models, non-core food intake was 151 % higher (ratio; 95 % CI) in EO at ‘Eateries’ (2·51; 2·14, 2·95) and 88 % higher at ‘School’ (1·88; 1·65, 2·13) compared with ‘Home’. EO with ‘Friends’ (1·16; CI 1·03, 1·31) and ‘Family & friends’ (1·21; 1·07, 1·37) contained 16–21 % more non-core food compared with eating ‘Alone’. At the individual level, total energy intake and BMI, but not social class, gender or age, were weakly associated with more non-core energy intake.
Regardless of individual characteristics, adolescents’ non-core food consumption was higher outside the home, especially at eateries. Targeting specific eating contexts, not individuals, may contribute to more effective public health interventions.
Conservation resources are limited, yet an increasing number of species are under threat. Assessing species for their conservation needs is, therefore, a vital first step in identifying and prioritizing species for both ex situ and in situ conservation actions. Using a transparent, logical and objective method, the Conservation Needs Assessment process developed by Amphibian Ark uses current knowledge of species in the wild to determine those with the most pressing conservation needs, and provides a foundation for the development of holistic conservation action plans that combine in situ and ex situ actions as appropriate. These assessments allow us to maximize the impact of limited conservation resources by identifying which measures could best serve those species requiring help. The Conservation Needs Assessment complements the IUCN Red List assessment, and together they provide a more holistic guide to conservation priorities and actions. Conservation Needs Assessments generate national prioritized lists of species recommended for conservation action. These can subsequently be used to assist in the development of species recovery plans and national action plans, or to inform national conservation priorities better. Additional tools that will evaluate the recommendations for ex situ rescues, to determine the best candidates for conservation breeding programmes, are currently under development.
Despite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.
Materials and methods
The modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation.
Paediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting.
Nutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.
The objective of the present study was to evaluate intakes and serum levels of vitamin A, vitamin E, and related compounds in a cohort of maternal–infant pairs in the Midwestern USA in relation to measures of health disparities. Concentrations of carotenoids and tocopherols in maternal serum were measured using HPLC and measures of socio-economic status, including food security and food desert residence, were obtained in 180 mothers upon admission to a Midwestern Academic Medical Center labour and delivery unit. The Kruskal–Wallis and independent-samples t tests were used to compare measures between groups; logistic regression models were used to adjust for relevant confounders. P < 0·05 was considered statistically significant. The odds of vitamin A insufficiency/deficiency were 2·17 times higher for non-whites when compared with whites (95 % CI 1·16, 4·05; P = 0·01) after adjustment for relevant confounders. Similarly, the odds of being vitamin E deficient were 3·52 times higher for non-whites (95 % CI 1·51, 8·10; P = 0·003). Those with public health insurance had lower serum lutein concentrations compared with those with private health insurance (P = 0·05), and living in a food desert was associated with lower serum concentrations of β-carotene (P = 0·02), after adjustment for confounders. Subjects with low/marginal food security had higher serum levels of lutein and β-cryptoxanthin compared with those with high food security (P = 0·004 and 0·02 for lutein and β-cryptoxanthin). Diet quality may be a public health concern in economically disadvantaged populations of industrialised societies leading to nutritional disadvantages as well.